End-User Information:
 
First Name*
 
 
Last Name*
 
 
 
Email Address*
 
 
Phone Number*
 
 
Job Title
 
 
Company Name*
 
 
 
 
Address*
 
 
City*
 
 
 
State/Province*
 
 
Country*
 
 
Zip / Postal Code*
 
 
 
End-User ERP Details:
 
GP Company Site Name
 
 
MS Account Number*
 
 
ERP System and Version*
 
 
# of ERP Users*
 
 
Length of time on GP or AX*
 
 
If subscription, duration of initial contract
 
 
 
Value-Added Reseller (VAR) Information:
 
VAR / Partner*
 
 
VAR Contact Name*
 
 
VAR Contact Email*
 
 
 
Products Purchased:
 

To place an order, please provide one of the following:

  • the P.O. detailing the products and pricing being ordered, or

  • the original Quote PDF provided to you by your Partner Account Manger, or

  • fill in the fields below

 
Attach a file
 
 
Products Purchased
 
 
Binary Stream Modules Purchased